Deaf Culture

Contributors

Reviewers

Kelsie Bennett, BA - Utah

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History

Throughout history, the deaf have been viewed as inadequate or inferior to those who hear. Because they had not learned speech in the majority of cases, they were thought to be incapable of thinking (13).

Plato concluded that “deaf people must not be capable of ideas or language;”

Aristotle similarly said “those who could not speak were unteachable’ (2).

These incorrect conclusions would form biases that would last through the Middle and Dark Ages. A prime example was that Roman law, a deaf persons was not allowed to own any property (17). History shows the deaf were periodically seen as having demonic possession.

18th Century

During the 18th Century, a French educator, named Charles-Michel de l’Épée noticed that deaf people were using hand signals to communicate with each other. He studied their language, learned it, and helped bring awareness to the deaf community.

1750’s – Schools for the deaf were formed and children were brought there to be educated. These schools were residential (2).

Two movements concerning the deaf began to form; oralism and manualism.

The 19th century would see large amounts of change for the deaf community. During the early part of the century, deaf people were kept isolated from each other (7); researchers during that time also posited laws should be passed to prevent the deaf from marrying and having children in order to not encourage deafness to continue (9).

1840’s - A French physician, Jean-Marc Itard, performed various experiments on deaf children to try and restore hearing; none were met with success. This would aid in fueling the oralist movement. One of the most notable supporters of the oralism movement was Alexander Graham Bell, the inventor of the telephone. His wife and mother were deaf, and he also taught deaf children. (1)

1860’s - The United States Congress passed a law mandating oralism as the way to teach deaf children and outlawed sign language.

1865 - The amount of schools teaching sign language would plummet from 26 in 1865 to 0 in 1907 (17). This would have a negative effect on the education of deaf people that can still be seen today.

1880’s - An international conference was held in Milan, Italy, which officially endorsed oralism as the method to be taught to deaf children (7). This would bring in the era considered the Dark Ages for Deaf culture. [KJ2]

Helen Keller is a notable and prominent figure in history to support and advocate for those with sensory deficits.

1880 - Schools for the hearing impaired numbered 55.

1900 - Schools for the hearing impaired rose to 112. Oralism was taught at these schools; however, speech was thought to be a “mere accessory” (16). While signing was not allowed during class, it was performed in secret and outside of class anyway.

1960’s American Sign Language (ASL), which is a mix between native signs American Deaf people used and French sign, began to be recognized as a language with the help of William Stokoe (pronounced STOH-kee); it was previously considered to be a primitive version of English (2) (7). This would help improve and validate the status of the Deaf community. [KJ3]

1964 - Congress issued the Babbidge report condemning oralism (17). This was the same year the Test Telephone {use of telephones for the hearing impaired} (TTY) or Telecommunications Display Device (TDD) telephone were developed (7).

1970’s - Sign language began to reemerge in the classrooms (9). The ban on signed languages was also lifted, and “total communication” was introduced – the simultaneous use of speech and sign (2).

1972 - Closed caption became available on limited television programing (17).

1980’s - The Deaf community desired closed caption to be more readily available during the 1980’s and held protests to be “heard” (7).

1986 - In movies, deaf people were frequently portrayed as the comedic unintelligent person or the unintelligent person in general. This changed in 1986 when Paramount Pictures released the motion picture, Children of a Lesser God starring William Hurt and Marlee Matlin (2). Matlin’s role in the film “finally allowed audiences to recognize the power and beauty of sign language” (2).

1988 - Gallaudet, one of the deaf colleges in the United States, students held a protest which was called Deaf President NOW (DPN) and took over the college campus in response to a hearing president being selected. They wanted a Deaf president; this demand was met after the appointed president resigned (17) (7). [KJ4]

[KJ1]At this time there were more then one signed language, even within a community, to be accurate it must be signed languages.

[KJ2]This portion would need to be considered Deaf culture not deaf culture. Those who are a part of deaf culture do not view it as the dark ages, they often times don't even know that the dark ages even existed.

[KJ3]IF this is going to be included, you NEED to include information about Thomas Gallaudet going to France to find a signed language for a girl named Alice Cogswell. The best way to get this portion of history accurately would be to talk to the ASL professors in the language department, they have a lot of texts that explain this very important part of history. Without Thomas Galludet, the first school for the Deaf wouldn't have come to America.

[KJ4]I would include information about the names, those names are considered very important to the Deaf community. Also I would make a small note that it happened again for a shorter amount of time when I. King Jordan retired.

Culture

An estimated 35 million people are deaf or hard of hearing in the United States (8). One in 1,000 children is born with severe to profound hearing loss. 20 million people have hearing loss, with the expectation the numbers will increase as the baby boomers age (13) (9). It is also important to note that 50% of persons over the age of 80 have significant hearing loss (9). Profoundly deaf is considered to be when more than a 90 decibel range of hearing loss is found; any degree of hearing loss is considered hard of hearing (13). The average range of hearing is 0-20 decibels.

The Deaf community is considered to be a group of people who live in a particular geographical location, share the common goals of its members and in various ways work toward achieving these goals. The Deaf community may include persons who are not themselves deaf[KJ1] , but those who actively support the goals of the community and work with Deaf people to achieve them. (18) Other populations of the community include those who are “oral” (speak) and deaf, hard of hearing, and persons with the varying degrees of hearing loss (4). The Deaf may be willing to accept hearing children of deaf parents (CODA/KODA) and interpreters as part of the community. Common punctuation differences in literature have significant meaning; deaf correlates to the actual loss of hearing, while Deaf signifies the cultural identity (8).

The culture of Deaf people, however, is more closed than the Deaf community. Members of the Deaf community behave as Deaf people do, use the language of the (REMOVE THE) Deaf people, and share the beliefs of Deaf people toward themselves and other people who are not deaf. (18) The Deaf are very connected to each other simply because they are deaf; they feel they can relate to each other. Hearing people do not understand the challenges of the deaf. They tend to group together for support. The invention of the internet has only increased their connectedness. This connection may or may not extend to those that are non-White or don’t have American Sign Language (ASL) as their first language (non-native signers), however. These persons may be considered a second-class deaf person and social cues of rejection, such as controlling turn-taking when signing and avoiding eye contact, occur. Those with an ethnic background have a more profound disadvantage – they are expected to learn not only the deaf and hearing cultures, but their own ethnicity as well (6).

Hearing children of the Deaf have been seen as a bridge between the Deaf community and the hearing world. They use ASL when speaking to the Deaf and speak verbally to those who can hear. They understand the language and cultural differences. Some things may be funny in the Deaf community that hearing people would not consider funny. The reverse is also true. The Deaf sense of humor often portrays the advantage they have over the hearing person. One example: A Deaf man signing with his Deaf friend explains what happened when he came home late last night... ‘My wife was wide awake, waiting for me in bed, and she started swearing at me and giving me hell’. ‘So what did you do?’ ‘I turned out the light’ (8).

The hearing may use words that have a dual meaning. The Deaf do not. The English language and ASL have similarities but are also very different in how they convey meaning. ASL is expressed in pictures and is very visual. They use facial expressions and body language to convey meaning. ASL simply expresses the core of the idea and not the extra expressive words offered in the English language. Due to this difference, the Deaf usually have a more simple vocabulary and may not know many of the English words and their meaning. This makes it difficult to fit in with the hearing world. [KJ2]

The Deaf culture and its influence has spread into other areas of our lives, which may be taken for granted. Most notable is the sports world; the hand signals used by umpires and pitchers are one such example (2). The huddle teams use to talk over strategies also originated from the Deaf community. A Deaf team was playing a hearing team; the deaf team would stand around using sign to communicate what “play” would be used next. A player on the hearing team knew sign language and informed his team of what the Deaf team would be doing. Once the Deaf team learned this, they huddled together so nobody from the opposing team could “eavesdrop” on their conversation (7).

[KJ1]I would make note that if they are not deaf they are often times an interpreter or a CODA/KODA which is Child of a Deaf Adult also considered a Kid of a Deaf Adult.

[KJ2]I would not say that sign language has a simple vocabulary, they have many words that English does not have, it is actually a very complicated language. Many Deaf actually get very offended when people make ASL seem simple.

Values and Norms

The Deaf believe that the use of the hands should convey a picture or visual meaning. This is the way they communicate throughout the world. The majority of the Deaf in the United States communicate using ASL.

There is a general disassociation from speech in the Deaf culture. Some Deaf people may choose to use speech in community activities that involve non-Deaf people, such as mixed parties, parent education programs, or while representing the community in some larger public function. On the cultural level, however, speaking may not be considered appropriate behavior. Exaggerated speaking behavior is thought of as "undignified" and sometimes can be interpreted as making fun of other Deaf people. (18)

The Deaf use lights in the home to help them know when an external cue is happening; for example, the doorbell, an alarm clock, or phone. When the telephone was first invented, the deaf were largely excluded from use. In order to use the telephone, they would need to find a hearing person who could communicate for them. It is said that many deaths happened when a person had a medical emergency but couldn’t find someone to phone emergency services on their behalf. This changed when the first TTY or TDD phone appeared in 1964 (7). The Deaf would communicate to the hearing through a communication assistant (CA) on the phone. The hearing person would say something; the CA would type what was said so the Deaf person could read the words. The Deaf person would then type something back, and the CA would read aloud what the Deaf person typed. While it was initially appreciated, the Deaf eventually grew to dislike this system as it was not private, slow, and cumbersome. Some of the advancements now include a Voice Carry Over (VCO); Deaf persons who can speak like to use this feature (10). The Video Relay Service (VRS) is a type of video telephone that may eliminate the use of a live CA. The system will translate using voice recognition and is therefore quicker and much more private to use.

With Deaf people not being able to call out a person’s name, they are given a sign-name. These sign-names are given to someone by a Deaf person, and have something to do with the person’s character, personality, or even a memorable story/event that had a significant effect on the person’s life (7). [KJ1]

[KJ1]Sign names were created so you do not have to continuesly fingerspell a persons name, not all people have signed names including Deaf people. If their name is short like "Dan" they most likely do not have one. Also their are two types of name signs. One being a persons character, personality, and a memorable story. The second type is something simple like having a letter shaken in the air or next to the signers face. It is usually used when they don't want to fingerspell someones name that they are often fingerspelling.

Traditions, Beliefs and Attitudes

Traditions are usually passed down from the families in which the Deaf child was raised. Beliefs can vary widely within the Deaf community. An example, members of any audience where there is a Deaf speaker or performer should applaud by waving their hands, "Deaf-Culture" style[KJ1] . It is a matter of simple courtesy. If the audience applauds by clapping their hands in the conventional "Hearing" fashion, the Deaf speaker will probably see it and appreciate the thought-but waving hands applause will have a much deeper impact and be much more appreciated. (12)

Some Deaf individuals do not want to have to put effort into reading lips or learning new vocabulary words so that they can understand what is happening around them. They are content to just staying on the sideline doing their own thing and not involving themselves in the conversation or activity. It takes a great deal of energy and willingness to try to figure out what is going on around them. They often feel like they are always behind in the conversation. When a group of people start to laugh, the Deaf person doesn’t know what was so funny because they were not looking at the person speaking or could not read their lips because their head was turned. The joke is slowly explained to them, but is not nearly as funny when it needs to be explained afterwards. [KJ2]

While the hearing world largely views the Deaf as people with a disability[KJ3] , many Deaf consider themselves a minority and are proud of being deaf (8). A deaf child born to Deaf parents may be raised to have a negative prejudice towards hearing persons (11). The lack of equality between the hearing and Deaf world angers many Deaf people. In 1880 the National Association of the Deaf (NAD) was formed to protect themselves from discrimination. The Deaf are sometimes made to feel inferior, whether intentional or unintentional, by hearing people. Many have the view that hearing should be “fixed” via cochlear implants; the majority of Deaf people do not like this view and feel no need to be “fixed” (13). The Deaf like to focus on their abilities, what they can do, and not on the fact they cannot hear (7). Numerous Deaf learn to become wary of hearing people in general and healthcare practitioners in particular (9). For many Deaf people, being a part of the Deaf community is the only place they can feel truly equal. Deaf people self-report an increase in their self-esteem, agency, and an increase of Deaf activism (8)

[KJ1]I wouldn't have it written as "Deaf-Culture" style. Its simply how you applaud its their word for applaud/clap. They have it visual where as hearing community has applauding like they do because we rely so much on sound.

[KJ2]It is also having to be explained because Deaf humor is somewhat different then hearing humor. They at times do not understand jokes.

Sense of Self in relation to the hearing

The following is an example of a story told by a Deaf individual in English and then repeated in ASL.

When I was first learning Sign Language, I really embarrassed myself by signing something very wrong. I had no idea I needed to be so careful about how I signed certain words. So, I asked my deaf friend to teach all the bad words to me, so I would be sure never to use them by mistake. She didn't want to, but finally she said she would. So, one morning, we went to a restaurant for breakfast. Making me promise to never use them, she began showing me all the bad signs. After she had finished, I was practicing those signs to lodge them in my memory. While I was practicing this woman came to our table and stood there, not saying anything, just staring. I said hello, but she didn't answer. Suddenly, she turned to my friend and started signing very fast; I couldn't understand. When she left, I asked my friend what was wrong. She told me that woman was a cook in the restaurant, she was deaf, and she bawled my friend out for teaching me to swear in Sign Language! We were very embarrassed. (15)

This story is a direct translation from English to ASL. It illustrates the significant difference in the two languages. While in this written form, ASL does appear to be quite simplified when compared to English. However, when taken into account body direction, facial expression, grammatical changes, and the fundamental difference that ASL is spoken in picture form, one may come to the realization that it is not as simple as it first appears. [KJ1]

Most Deaf people don’t consider themselves disabled. For others it may depend on how they were raised and the influences present while growing up. Some Deaf people are raised orally with no connection to other Deaf persons; if their parents believe that deafness is a disability and want to “fix” their child, the child may grow up to have this same thinking pattern (9) (2). If a Deaf person was taught to use speech as a child, they are generally classified into oral “successes” and oral “failures” (7). Successful oral Deaf persons are those who speak with little to no Deaf accent and are understood very well by hearing people. Deaf oral failures are those who are more difficult to understand. These labels may or may not have an effect on how a Deaf person views themselves and how much they will integrate themselves into the hearing world. The Deaf don’t have the ability to absorb knowledge like the hearing do; conversations heard on the radio or at the store that may teach something to a hearing person do not occur with a Deaf person

Communication Style and Language

American Sign Language (ASL) is the preferred communication method of the Deaf. ASL may be compared to short hand or cave man talk. It only uses the main words or concepts in the sentence. The rest of the meaning is done through body language and facial expressions. It is another language. When the English language is spoken, many unnecessary words are added to communicate with the Deaf; they get lost in all the superfluous words. Most of the Deaf do not get past a 2nd to 3rd grade vocabulary level. (5). Since ASL is primarily a non-written language, it is difficult to translate, but hearing individuals tend to want to translate it into English in some broken form. The wording order is quite different; for example, a physician stating ‘you may need surgery’ might be understood by a Deaf person as needing surgery in the month of May (13). William Stokoe, who was instrumental in helping recognition of ASL as another language, did invent a written form of sign language. It is drawn heavily on the Latin alphabet and requires much study before understood. Another form of written ASL, called SignWriting, is more picture oriented than the Stokoe notation, but again would require study prior to understanding. It is unclear whether these written forms have and should be taught to children.

Signing is defined as a “series of pictures that convey meaning” (13). Many of the ASL signs have a history as to why it represents something. For example, the sign for “man” or “boy” is done by touching the rim of a hat on one’s forehead. The sign for “girl” or “woman” is made by moving one’s extended thumb down the cheek or jawbone with the hand in a fist shape. [KJ1] This represents the bonnet string worn by women in years past. Each person has a little different style in signing, similar to the difference or accent that the hearing have when they speak. Much like when a hearing person can tell where another is from based on how they speak, the Deaf are able to do so as well. For example, most African Americans use more body language and emphasis with their facial expressions when signing than their non-African Americans counterparts (7).

Sign language is different in every country[KJ2] , just like the verbal languages are different. But everywhere you find Deaf people, you will find some sort of sign language. The impulse to sign is universal. Deaf children not exposed to any standard sign language will invent their own sign systems. (12) Even hearing people use hand gestures to communicate.

25% of children that have a profound hearing loss have an additional handicap, most of the time a learning disability (17). The ability to learn English, whether spoken or written, is largely affected by when the child became deaf. If a child became deaf after he/she begins to learn language, or already has learned language, they are referred to as postlingually deaf. A child who becomes deaf prior to learning language is referred to as prelingually deaf. Persons who are postlingually deaf generally learn to speak and read English with greater ease than those who are prelingually deaf as they had some kind of baseline of language before becoming deaf (13). Deaf people who were prelingually deaf generally use ASL as their main form of communication. The majority of Deaf people have parents not fluent is ASL, which may strain family communication (13).

Some things hearing people can do to ensure a satisfactory experience with a Deaf person include maintaining eye contact, including them in conversations, and communicating when an external cue happens (i.e. phone ringing, doorbell, etc.) (13). There is a misconception that the Deaf live without sound; the opposite is actually true. Many Deaf people enjoy music as they tend to be more sensitive to the vibrations it produces

[KJ1]Not accurate what was explained is the sign for boy and the sign for girl. Their are seperate signs for man and woman.

Food and Feeding Habits

The Deaf people eat just like others, except for the fact that they can’t hear. They may make chopping and other mouth noises that a hearing person would correct. There are no special diet restrictions other than their own individual needs. One point to consider is, if a Deaf person can read lips and is trying to communicate during a meal, it is important for the hearing person to not try to talk and chew at the same time. The Deaf lip reader cannot tell the difference between chewing and words spoken.

Relationships and Social Organization

Being in groups of hearing people can bring a lot of anxiety to Deaf people. They are not able to keep up with what’s happening. Even the most educated and willing Deaf person will be somewhat excluded from the conversations happening in a group setting with hearing people. The Deaf are very conscious of body language and facial expressions used even though they may not be able hear or understand what is going on. This is the sense that they use to try and compensate for not being able to hear. They can pick up on body language cues but this can also be a source of miscommunication as well. Sometimes body language does not truly match with what is being said.

Only 4% of children born deaf have deaf parents. Within the Deaf community, these children are viewed as the ideal Deaf children, and they will then continue the language and culture of the Deaf. This may be in part because hearing parents of deaf children largely view hearing as something to be fixed. Deaf people generally believe hearing parents that opt to insert cochlear implants view their child as defective (11). As the majority of deaf children are born to hearing parents, however, many more children are now having cochlear implants inserted, thereby reducing the size of the Deaf community in general (3). [KJ1]

Hearing children of Deaf parents have a strong affiliation to the Deaf culture because of being raised in the culture. They tend to be accepted by the Deaf community a little easier. Some are very fluent in ASL and sign like a Deaf person. These children are links to the outside world for the Deaf and they are often asked to be interpreters. These children are able to understand both cultures and will usually adapt to each differently.

Animosity exists between the Deaf and hard of hearing. While there is a parameter (90 decibel loss) for being deaf, any degree of hearing loss may be classified as hard of hearing. People who are hard of hearing generally don’t feel as if they belong in either world, hearing or Deaf (13).

[KJ1]Note though, many children that do grow up with cochlear implants do learn sign language later in life and become a part of the Deaf community, not all but many.

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Education and Learning

A study published in 1972 found that the average English reading level of deaf high school graduates was at the fourth grade level (2). Another study in 1974 similarly showed 30% of deaf Americans were illiterate, and 80% had jobs that required manual labor (17). One of the most damaging effects still seen from the outlawing of sign language and promotion of the oralist method in the 19th century is that of education. As the oralist method increased, the level of educational success proportionally decreased (9). Since communication is frequently the major obstacle the Deaf face, often the English proficiency is decreased (8). Even well-educated Deaf people may have difficulties understanding written English (13).

The majority (85%) of deaf children are “mainstreamed,” or attend school with hearing children. Other Deaf children will go to an elementary, junior high and high school specifically for the Deaf and will use ASL primarily to communicate. The teacher will teach using ASL, making sure to face the class so each student can see and understand. This education is significantly different than that of a hearing child's. They might not learn to read and write with the same level of vocabulary and sentence structure. Educators of the Deaf are divided between the manualist method and the oralist method; if the deaf child’s parent opts to have their child attend a Deaf school, they often can choose the school according to the theory taught (17) (7).

If the Deaf want to go to college, they most likely will have an interpreter. This brings challenges because there is not a direct translation for many of the words taught, so they have to be spelled out[KJ1] . This takes increased time and the instructor may not want to slow down, therefore they may get lost in the vocabulary before even understanding the subject. Most Deaf people don’t attend college (9). Edward Gallaudet (1837-1917) was a key figure in establishing the first deaf college in the United States, which later bore his name, Gallaudet University, in 1857 (7). It is still one of the most prestigious Deaf universities in the country today.

[KJ1]they don't just fingerspell the word, they fingerspell, describe what it means and the fingerspell it again. It is difficult, because of the slow process of doing so, can make it so that interpreters fall behind. Example, their is not sign for photosynthesis, so they fingerspell it, explain and fingerspell again and try to show what it means with very few signs, and at times they will decide on something to be the sign while discussing the topic.

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Work Habits and Practices

Many laws have been passed in order to end discrimination such as the Vocational Rehabilitation Act Amendments, passed in 1965, which allows for rehabilitation center funding and case service funds for sign-language interpreter service. However, even after earning a college degree and with the mandated assistance and accommodations, finding and maintaining a job can be a very difficult task for a Deaf person.

A 1991 report showed that the Deaf and Hard of Hearing population on average had lower income, increased unemployment, decreased education, and increased blue collar/service industry jobs than the general population (9).

The Deaf have to be careful in choosing an education that will lead them to a successful career. Employment is equal opportunity employment, but if any part of the job requires hearing, the Deaf may not be able to perform some of the functions required, so they may not be considered capable to do the job by the employer. Also, if the employer is not patient or willing to put in the extra time needed to communicate with the Deaf employee, frustration will likely increase on both sides. Communication with the Deaf takes time and in today’s fast paced world, many employers are not willing to take the time. The Deaf often choose to do a job or career that is more manual and therefore requires less communication with others.

With this in mind, it is unsurprising that Deaf people tend to work in more blue collar jobs than their hearing counterparts (7). In 1965, the National Technical Institute for the Deaf (NTID) was opened in New York, and is currently the largest technical college for Deaf and Hard of Hearing students. Various undergraduate and graduate degrees are offered, http://www.ntid.rit.edu/.

Healthcare

The healthcare world has categorized Deaf people as aggressive, immature, impulsive, lazy, stubborn, suspicious, and unintelligent. None of these terms promote good healthcare, and providers should work to avoid miscommunications as much as possible to ensure adequate care (13). Often the Deaf and Hard of Hearing populations receive healthcare that is inadequate, inappropriate, and may even be unethical. The Deaf population in general has poorer self-reported health than the hearing population. The incidence of hearing loss increased 53% between the years 1971 and 1991. Over 200 types of genetic hearing loss has been described. As 90% of deaf children are born to hearing parents, the majority of hearing parents turn to the medical community for solutions. Approximately 50% of all hearing loss cases are genetically linked (9). Surgical solutions, most often in the form of cochlear implants, are stressed by physicians (8). Many parents feel the need to “fix” hearing and as a result opt to have the implants placed (9) (3).

As a Registered Nurse (RN), it would be important to recognize:

• The importance of building strong relationships based on mutual respect and trust. Being welcoming to the Deaf person may likely increase the level of satisfactory care both received and given (8). It is most unfortunate that most people with any type of disability don’t feel healthcare providers see them as an actual person (9).

• The need to avoid making judgments about the Deaf based on their inability to hear. Hearing people can never understand exactly what it is like to be Deaf (11). Also, Deaf people tend to have increased anxiety and are more distrustful when it comes to their healthcare; allowing them to participate as much as they are able may foster a change in feelings and attitudes.

• For most Deaf people, English is a foreign language not easily understood or used for reading and writing. This can be problematic when they are asked to read and sign legal consent forms and other written documents. When giving out pamphlets or other educational materials, it may be wise to assess the level at which a Deaf person reads.

• Shouting will not usually increase the Deaf person's comprehension or ability to hear, and since they are more attuned to vibrations you run a high chance of offending them by doing so.

Most medical training programs emphasize the importance of a medical history in understanding what is happening with a patient and how to treat it. However, since communication may be difficult with a Deaf person, the medical history tends to be overlooked or is not as in depth as a hearing patient’s history would be. This, as well as the decreased ability to read English with many Deaf patients, contributes to the decrease in adequate healthcare the Deaf population receives. The relationship between literacy skills and medical costs has been shown to be an inversely proportionate one. The lower the literacy of a Deaf person, the higher the medical costs in general. This may be in part due to a general trend of Deaf people returning to a practitioner to ask questions and increase understanding of what happened at their previous visit (9). Many Deaf patients don’t want to appear unintelligent when they don’t understand something said or asked of them, so in general they may nod to show understanding. This also indicates they tend to be passive in their healthcare and are unsure how to navigate the healthcare system (9). It would be wise to make sure they understand. Also, be prepared for the possibility of cognitive delays, as for some Deaf people language may not have been learned at the age needed to prevent such delays. Conversely, having a patronizing attitude may create more negative feelings (13).

Family members cannot be legal interpreters. They often don't know the medical terms and are emotionally or personally involved, and could have interests that conflict with the patients’. Family members used as interpreters also causes problems with patient confidentiality by violating Health Insurance Portability and Accountability Act (HIPAA) laws. (14). Not all Deaf patients may desire an interpreter. The Deaf community in any one area tends to be small, with many people knowing each other. Providing an interpreter the Deaf patient may see in another setting other than the healthcare facility may make the Deaf patient uncomfortable (13).

Exchanging written notes may be effective for brief and simple communication but should not be used for written consent or complex conversations. Writing takes time and important details may be left out. Lip reading can be used but also has its limitations. On average, even the most skilled lip readers understand only 25 percent of what is said to them, and many individuals understand far less. (14). A better choice might be to ask the patient what their preferred method of communication is; written, oral, interpreter, etc. If the patient does choose to communicate orally, make sure to face the Deaf person and get close, with no obstruction to the face such as a surgical mask. If an interpreter is present, it is considered more polite to speak directly to the Deaf person instead of the interpreter. It may also be wise to avoid inserting an IV into Deaf patient’s hands, allowing them more freedom to use ASL (13).

Lip-reading is most often used as a supplement to the use of hearing aids. Because lip-reading requires some guesswork, very few deaf or hard of hearing people rely on lip-reading alone for communication of important information. Lip-reading may be particularly difficult in the medical setting where medical terminology is used. As with the general hearing population, it should not be assumed that a Deaf person can understand medical terminology. Make sure to speak to the level of their understanding. Another matter of importance is to avoid categorizing Deaf persons and Hard of Hearing persons together. Try to understand the level of hearing loss and adjust care to that. Deaf people are more attuned to body language and facial expressions, so the healthcare provider might be careful of the facial expressions given so as to avoid causing the patient undue anxiety. Learning a few basic signs may help decrease anxiety for the Deaf patient as well (13).

The incidence of human immunodeficiency virus (HIV), sexually transmitted infections (STI), sexual abuse, alcohol abuse, and substance abuse is increased in the Deaf community (13). On average the education about HIV is eight years behind that of the hearing community. A decrease in education about safe sex practices and substance abuse has been noticed as well (9).

Title III of the Americans with Disabilities Act (ADA) prohibits discrimination against individuals with disabilities by places of public accommodation. Private health care providers and hospitals are considered places of public accommodation and they have a legal obligation to provide an interpreter or another alternative for needed communication assistance. However, may providers are unaware they are legally obligated to have not only a certified ASL interpreter, but one trained in medical terminology as well (13). Some providers may try claim an undue burden to get out of providing these services. Showing an undue burden may be difficult for most health care providers. When an undue burden can be shown, the health care provider still has the duty to furnish an alternative auxiliary aid or service that would not result in an undue burden and would ensure effective communication (14). An option providers may consider is the use of internet and webcams for interpretive services (13).

Eligible small businesses may claim a tax credit of up to 50 percent of eligible access expenditures that are over $250, but less than $10,250. The amount credited may be up to $5,000 per tax year. Eligible expenditures include the costs of qualified interpreters and other auxiliary aids and services. (14)

Van Drenth, A. (2003). "Tender Sympathy and Scrupulous Fidelity": gender and professionalism in the history of deaf education in the United States. International Journal of Disability, Development & Education, 50(4), 367-383. doi:10.1080/1034912032000155176